Coding Tobacco 01

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Coding Tobacco Use/Abuse/Dependence
January 7, 2015
Vol. 3
Coders participating in dual coding are struggling with how to code
tobacco use, abuse and dependence.
If we consult the ICD-10-CM Official Guidelines for Coding and
Reporting FY 2015, pages 34-35, we are given a hierarchy for coding
Use/Abuse/Dependence:
Helpful advice comes from AHA Coding Clinic, 4th Quarter 2013, p 109,
which discusses the fact that the provider must document a cause and effect
relationship between smoking and other disease processes before the coder
may link the disease process to smoking.
•
Example based on this Coding Clinic: Patient is a current cigarette
smoker with a 20 year history of smoking who now presents with
emphysema. The physician does not link the smoking to the
emphysema in the medical record; therefore, it would not be
appropriate for the coder to use F17.218, Nicotine dependence,
cigarettes, with other nicotine-induced disorders.
• If both use and abuse are documented, assign only the code for
abuse
• If both abuse and dependence are documented, assign only the
code for dependence
• If use, abuse and dependence are all documented, assign only the
code for dependence
• If both use and dependence are documented, assign only the code
for dependence.
What about E smoking?
Electronic cigarettes are battery-powered vaporizer devices that turn liquid
nicotine into a vapor that can be inhaled; therefore, they could be considered
to be a “Nicotine inhaler.”
0 ICD-10-CM Index
Guidance for coding Tobacco Use/Abuse/Dependence
when using the ICD-10-CM Codebook:
•
•
0
Follow the index in the ICD-10-CM code book for the appropriate
code for Tobacco Use/Abuse/Dependence:
•
Nicotine – see Tobacco
ICD-10-CM Index
• Tobacco (nicotine)
Use (of ) tobacco codes to Z72.0, but it may not be reported
with a code from F17 (Nicotine dependence) per Excludes1
note with Z72.0 and F17
0
dependence —see Dependence, drug, nicotine
0
harmful use Z72.0
•
There is no code for tobacco abuse
0
heart —see Tobacco, toxic effect
•
Dependence, tobacco directs the coder to - see Dependence,
drug, nicotine
0
maternal use, affecting newborn P04.2
0
toxic effect —see Table of Drugs and Chemicals, by
substance, poisoning
•
Dependence, drug, nicotine codes to F17.200,
•
•
•
Chewing tobacco
•
Cigarettes
•
Specified product
use Z72.0
• complicating
• childbirth O99.334
Uncomplicated
• pregnancy O99.33-
•
In remission
• puerperium O99.335
•
With withdrawal
•
With other nicotine-induced disorders
•
With unspecified nicotine-induced disorders
•
Code assignment for a pregnant patient who smokes requires
two codes, O99.33- (Smoking (tobacco)complicating pregnancy,
childbirth, and the puerparium) plus an F17 (Nicotine
dependence) code for the type of tobacco
•
0
•
The term “Smoker” in the CD-10-CM index, refers the coder to see Dependence, drug, nicotine
•
• cigarettes —see Table of Drugs and Chemicals,
by substance, poisoning
Subcategories under F17 (Nicotine dependence) identify
specific nicotine-induced disorders including:
•
•
• chewing tobacco —see Table of Drugs and
Chemicals, by substance, poisoning
Subcategories under F17 (Nicotine dependence) identify
specific tobacco products including:
• counseling and surveillance Z71.6
0
withdrawal state —see Dependence, drug, nicotine
Therefore, based on documentation found in the medical record, the correct
coding path would be selected under the Main Term “Tobacco” in the
ICD-10-CM Index, and then verified in the ICD-10-CM Tabular.
Final thoughts concerning tobacco use/abuse/dependence:
•
Of the F17 (Nicotine dependence) codes, only those specifying
dependence “with withdrawal” are a CC, none are an MCC
•
Code assignment for a patient who has a past history of
tobacco dependence, not current dependence on tobacco,
codes to Z87.891 (Personal history of nicotine dependence)
None of the O99.33_ codes are a CC or MCC (These are the obstetric
codes for smoking complicating pregnancy, childbirth and the
puerperium)
•
There is no code for past history of tobacco use, only a code for
past history of tobacco dependence
P04.2 is not a CC or MCC (This is the pediatric code for newborn
affected by maternal use of tobacco)
•
Z72.0 is not a CC or MCC (This is the problems related to lifestyle code
specifying tobacco use)
•
Please use the documentation provided in the medical record as well
as the index in the ICD-10-CM code book to guide your code choice
Tobacco dependence in remission is coded differently than past
history of tobacco dependence, and the information is given by
the sixth character “1” in the F17 (Nicotine dependence) codes.
•
Example: F17.211 Nicotine dependence, cigarettes, in
remission
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www.antheliohealth.com
The ICD-10 Fun Corner
Anthelio’s ICD-10-PCS CrossCode Puzzle
4
4
1
1
2
3
2
3
ICD-10-PCS Procedures:
(The answers are Codes and not words)
Across
1.
2.
3.
4.
Ventricular-peritoneal Shunt, Open Approach
Insertion of endotracheal tube, via Natural Opening
Mechanical ventilation, 52 hours
Brachytherapy of brain with low dose Palladium
Down
1.
2.
3.
4.
Open total cholecystectomy
Laparoscopic Appendectomy
Peritoneal dialysis via indwelling catheter
Endoscopic radial to median nerve transfer
The answers are on the next page.
© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved.
www.antheliohealth.com
Solution
0
4
D
0
1
4
0
B
B
Z
X
02 J
6
F
D
4
T
T
Z
33
4
J
5
E
0
4
Z
Z
Z
Z
1
2
0
B
H
1
7
0
E
M
01 1
6
3
3
5
A
1
9
4
5
Z
Z
ICD-10-PCS Procedures:
Across
1.
2.
3.
4.
Ventricular-peritoneal Shunt, Open Approach
Insertion of endotracheal tube, via Natural Opening
Mechanical ventilation, 52 hours
Brachytherapy of brain with low dose Palladium
© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved.
Down
1.
2.
3.
4.
Open total cholecystectomy
Laparoscopic Appendectomy
Peritoneal dialysis via indwelling catheter
Endoscopic radial to median nerve transfer
www.antheliohealth.com